Workers’ Compensation is regulated by state law and is not administered in the same way as your group medical insurance policy. Workers’ Compensation benefits covers industrial injury and illness for Diocese of San Jose employees and begins on your date of hire. Our third party administrator who manages our claims is Athens Administrators, P. O. Box 696, Concord, CA 94566, (866) 482-3535.
Workers’ Compensation benefits do not cover injuries arising from volunteer participation or any pre-existing condition, off-duty recreation, social, or athletic activity that is not work related.
Please note Clergy and Religious Sisters are not covered under workers’ compensation. Their respective orders take care of any occupational injuries and associated medical expenses.
- Staff Administrator Guidelines & Procedures
- Employee Guidelines & Procedures
REPORT A CLAIM
- Provide the DWC-1 to injured/ill employee within one working day of date of injury. Upon receipt of DWC-1, employer is to fill out the Form 5020. Complete Supervisor’s Injury and Illness Investigation Report.
- To expedite the claims process, employers may login to Claim Compass online: Claim Compass to automatically generate a Form 5020 only. The DWC-1 is always given as a hardcopy.
- Within one working day, send all copies to Human Resources at the Chancery to Caroline Zelaya – fax (408) 983-0203 or scan and email to firstname.lastname@example.org; and Athens Administrators at (925) 609-5468.
CAL – OSHA
All employee accidents that require an overnight hospital stay and/or result in death must be reported to CAL-OSHA within 8 hours of the occurrence. If you fail to report the incident CAL-OSHA will fine your location. (510) 794-2521 or 1-(800) 736-7401 (Ask for the officer of the day)
MEDICAL PROVIDER NETWORK (MPN)
Unless the employee predesignated their personal physician in writing prior to a workplace injury, they must see a doctor within our MPN.
Click on this link to view a complete list of medical providers within our network (MPN) should you need medical attention for your workers’ compensation injury:
When making an appointment, please inform the physician that you have a workers’ compensation injury.
For dental concerns, please click on the link below:
MANDATORY FORMS AND NOTICES
- Notice to Employees – Injuries Caused By Work (Must be posted at school or parish)
- MPN Employee Written Notification (Must be posted at school or parish)
- Employee Waiver of Medical Attention Form
- DWC-1 – Workers’ Compensation Claim Form
- Form 5020 – Employer’s First Report of Occupational Injury or Illness
- Supervisor’s Injury and Illness Investigation Report Form
- Employee’s Temporary/Modified Duty Assignment Form